Step 1 P/F: Decision

[efle]

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We also have to keep in mind that medical treatments, understanding, and diagnostics have exploded over the last 10-20+ years. I imagine med school was easier in 1985 when there were 1/3 of drugs and 1/2 of the diseases etiologies were logged as “idiopathic”.

Be careful man. These SDNers are going to burn you at the stake for saying this. I had to lock my post earlier because they all came after me.

At the same time, the specialties that have evolved to expect 250s (essentially surgical subs and Derm) are the ones that least need the extensive pathophys knowledge of general medicine zebras. Medicine will always get the consult on anything even slightly weird, and they aren't what fueled the arms race.

 

[Tastysalmon]

At the same time, the specialties that have evolved to expect 250s (essentially surgical subs and Derm) are the ones that least need the extensive pathophys knowledge of general medicine zebras. Medicine will always get the consult on anything even slightly weird, and they aren't what fueled the arms race.

Yeah it truly is interesting how that is haha. Knowing gaucher dx vs I—cell dx, etc truly is necessary for checking on that eczema... xD (disclaimer I know derm do more than eczema but I like to pick on my friend for this)

 

[NeuResurgens]

We also have to keep in mind that medical treatments, understanding, and diagnostics have exploded over the last 10-20+ years. I imagine med school was easier in 1985 when there were 1/3 of drugs and 1/2 of the diseases etiologies were logged as “idiopathic”.

Been saying this for a while. Seems like a few of the faculty occasionally treat us like we're just entitled millennials when we say a certain week or course is scheduled in a way that is too much even for us (e.g. an exam that we need to know 15 bacteria, 30 viruses, and 30+ abx the week after we had a 4 hour final exam for the previous course that weekend). There's a lot more to learn these days

 

[Lawpy]

 

[texan2016]

Been saying this for a while. Seems like a few of the faculty occasionally treat us like we're just entitled millennials when we say a certain week or course is scheduled in a way that is too much even for us (e.g. an exam that we need to know 15 bacteria, 30 viruses, and 30+ abx the week after we had a 4 hour final exam for the previous course that weekend). There's a lot more to learn these days

I agree with you, but just to play devils advocate we have tremendous resources now to learn like sketchy and zanki. In the 80s you had to drive to a medical library to figure out a question , now we know instantly. But yeah I think the amount of medical knowledge we learn in two years is insane and overwhelming

 

[deleted1017848]

x

 

[7331poas]

Does present an interesting thought experiment, though. If the MCAT did have a garbage interval that could barely distinguish a top decile applicant from someone at risk of needing extra years/board repeats...would there still be a vocal group of high scorers defending it's role in medical admissions?

Probably.

...yes

Because without the MCAT, no one would ever matriculate into medical school if they are from an unknown school. What does it matter if you have a 4.0 from North Dakota Commonwealth U?

 

[efle]

...yes

Because without the MCAT, no one would ever matriculate into medical school if they are from an unknown school. What does it matter if you have a 4.0 from North Dakota Commonwealth U?

I think, again, that someone would have to be unfamiliar with recent history to buy into that fear.

TIL one decade ago, average MCATs at top medical schools were ~32-34

Found this during a discussion buried in another thread and through it warranted it's own space to be shared. I found this from a SUNY bio department webpage showing stats from 2006. Apparently, these schools were the only places with a 30+ MCAT in the early/mid 2000s. The best of the best...

forums.studentdoctor.net

A low 30s was competitive for any schools in the country in the mid 2000s. The national average admitted score was in the high 20s, which is about as low as it could safely get since mid 20s is the start of the danger zone.

This whole system of scores = merit = consideration is a new phenomenon in residency, and medical, and even college selection. It was not the case in 2005 that you had to be an Ivy Leaguer to get into medical school, despite their MCAT ranges being very relaxed, and yet somehow everyone thinks that would be the result. I don't understand why. State medical schools 20 years ago were sending plenty of students into surgical fields, and state undergrads were sending plenty of students to medical school.

Edit: Another piece of data to look at would be that all of the premed feeder powerhouses on this chart combined are only supplying 18% of med school applicants. It's a teeny tiny pool, just like it's only a few people per year from the high ranked med schools that go into a given surgical field. Even if med schools wanted to all exclusively pull from familiar undergrads, they couldn't.

 

[GastriqueGraffin]

I still wonder how PDs are going to screen the countless applications they will receive. I imagine basically limit it to US MD and remove anyone with major red flags but even this is too broad. I stand by what I said earlier... this change will not make for better residents or docs in general. Volunteering or research or whatever is usually superficial fluff and doesn’t reflect how studious someone is. Those who shouldn’t have gotten into med school because of a low MCAT but high grades usually (definitely but not always) struggle when they start and there is a reason for it. None of the material on the MCAT is at all relevant to medicine but it helps screen out a lot of bad applicants to school. Caribbean schools have played on this for a long time and have been able to make a pretty penny off of it. We will experience something similar with residencies now without step 1

 

[efle]

I still wonder how PDs are going to screen the countless applications they will receive. I imagine basically limit it to US MD and remove anyone with major red flags but even this is too broad. I stand by what I said earlier... this change will not make for better residents or docs in general. Volunteering or research or whatever is usually superficial fluff and doesn’t reflect how studious someone is. Those who shouldn’t have gotten into med school because of a low MCAT but high grades usually (definitely but not always) struggle when they start and there is a reason for it. None of the material on the MCAT is at all relevant to medicine but it helps screen out a lot of bad applicants to school. Caribbean schools have played on this for a long time and have been able to make a pretty penny off of it. We will experience something similar with residencies now without step 1

Hopefully they start clamoring for an application cap/limit, instead of for alternative crappy metrics to misuse

 

[deleted1039640]

The USMLE is now Pass/Fail but can someone give me a tl;dr of the potential ramifications? Does the prestige of the medical school one attends matter all the more now? Someone, please give me a rundown, I really don't want to have to run through 24 pages of riveting debate bahaha!

 

[Frogger27]

The USMLE is now Pass/Fail but can someone give me a tl;dr of the potential ramifications? Does the prestige of the medical school one attends matter all the more now? Someone, please give me a rundown, I really don't want to have to run through 24 pages of riveting debate bahaha!

tldr; No one knows: but speculation is that med school prestige will probably matter more, step 2 Ck will matter more until it becomes P/F too, which at this point school prestige will matter even more. LORs and research may also be more valuable

 

[deleted1039640]

tldr; No one knows: but speculation is that med school prestige will probably matter more, step 2 Ck will matter more until it becomes P/F too, which at this point school prestige will matter even more. LORs and research may also be more valuable

ily 😉

So when Step 2 CK becomes P/F, I suppose the importance will shift to Step 3? When are Steps 2/3 generally taken? Also, how will this effect DO schools as well as Caribbean MD and "low-tier" MD schools?

 

[ooh a bean]

ily 😉

So when Step 2 CK becomes P/F, I suppose the importance will shift to Step 3? When are Steps 2/3 generally taken? Also, how will this effect DO schools as well as Caribbean MD and "low-tier" MD schools?

No, step 3 is taken after medical school. School prestige will remain king, as it already is.

 

[texan2016]

a lowly premed who will be matriculating this fall but i was wondering if a 2 year preclinical curriculum puts students at a disadvantage if the emphasis is now going to be on step 2 ck?

I don’t think it matters either way , make the most of where your at.
here’s a list of schools step 1 and step 2 scores from a bit ago if your Curious

from reddit:

 

[ReturnToMed]

look at the hardos at ohio state.....

 

[NeuResurgens]

look at the hardos at ohio state.....

That's THE to you sir

 

[ReturnToMed]

That's THE to you sir

my response is your avi

 

[NeuResurgens]

my response is your avi

*Not an actual OSU fan*

 

[ace_inhibitor111]

Kind of an aside, but since this thread was bumped, I ran into this article earlier:

Why are medical students applying to an increasing number of residency programs?
Students worry that either they will not get interviews or that they will not get the interviews they want. Ironically, reduced emphasis on grades and current grade inflation appear to make some students insecure. If everyone gets a pass in a pass/fail course or honors in a graded course, there is no differentiation among students: students may not know how they are really doing. For some students, application to residency is the first time since application to medical school that they have had to compete for something. They do not know how they measure up against others. Thus, students may lack confidence and apply to 65 OHNS programs or more, just in case.

Viewpoint From a Program Director They Can't All Walk on Water - PMC

www.ncbi.nlm.nih.gov

 

[AnatomyGrey12]

Reporting USMLE Step 1 Scores as Pass/Fail: An Opportunity for Medical Education and Training

This Viewpoint discusses the rationale for the announced 2022 change in USMLE Step 1 examination scoring from a 3-digit score to a pass/fail designation, addressing concerns that the change might lead to a shift in the importance of Step 2 Clinical Knowledge scores and emphasizing it as one part...

jamanetwork.com

A few tidbits:

"To explore examinee wellness, the NBME created a task force called Re-Examining Exams: NBME Effort on Wellness (RENEW).4 Both organizations began substantive conversations to explore what was happening around them, guided by the shared commitment of the USMLE program to provide state medical boards with important measures of the competencies of a physician while trying to improve the overall climate of stress and anxiety among medical students."

Wellness is being thrown out there as a main driver of the decision.

"It is hoped that organizations involved with medical education and training will use the period between the announcement and implementation of the change as an opportunity to create a better transition from UME to GME so that the stress associated with Step 1 is not simply transferred to Step 2 Clinical Knowledge."

Lol if they think this won't happen they are delusional.

"Many osteopathic medical students take Step 1 and Step 2 Clinical Knowledge to compete for residency positions and, given this change, more students may be prompted to take Step 2 Clinical Knowledge. The National Board of Osteopathic Medical Examiners, which produces the 3-part Comprehensive Osteopathic Medical Licensure Examination for osteopathic physician licensure, is exploring score reporting changes to its examination. With a single accreditation system for GME nearing completion this year, there may be opportunities for collaboration to ease the transition from UME to GME for all medical students."

Opening line is kind of the middle finger to DO students, they make a lot of money off this because less DO students take Step 2 than Step 1. However if they get rid of the NBOME I will sing them praises. Ironically the first author is a DO.....

"The USMLE program will continue to work with UME and GME communities and others as they explore a process that supports a career journey for physicians that the public can trust."

This is the same garbage the NBOME uses to rationalize its existence. "Protecting the public" is a shield to hide from criticism.

However this right here might be the most telling line of all:

"While there was no unanimity among the various groups about the best path forward, following an internal review of possible Step 1 score reporting options, including the possibility of no changes or the adoption of other types of scoring, the staff and governance of the FSMB and NBME aligned around one decision—reporting Step 1 results as pass/fail."

I.e. "we know you didn't want this but we decided we were going to do it anyway."

Congratulations NBME, you just gave definitive evidence that you didn't really give this any actual foresight.

 

[NeuResurgens]

Reporting USMLE Step 1 Scores as Pass/Fail: An Opportunity for Medical Education and Training

This Viewpoint discusses the rationale for the announced 2022 change in USMLE Step 1 examination scoring from a 3-digit score to a pass/fail designation, addressing concerns that the change might lead to a shift in the importance of Step 2 Clinical Knowledge scores and emphasizing it as one part...

jamanetwork.com

A few tidbits:

"To explore examinee wellness, the NBME created a task force called Re-Examining Exams: NBME Effort on Wellness (RENEW).4 Both organizations began substantive conversations to explore what was happening around them, guided by the shared commitment of the USMLE program to provide state medical boards with important measures of the competencies of a physician while trying to improve the overall climate of stress and anxiety among medical students."

Wellness is being thrown out there as a main driver of the decision.

"It is hoped that organizations involved with medical education and training will use the period between the announcement and implementation of the change as an opportunity to create a better transition from UME to GME so that the stress associated with Step 1 is not simply transferred to Step 2 Clinical Knowledge."

Lol if they think this won't happen they are delusional.

"Many osteopathic medical students take Step 1 and Step 2 Clinical Knowledge to compete for residency positions and, given this change, more students may be prompted to take Step 2 Clinical Knowledge. The National Board of Osteopathic Medical Examiners, which produces the 3-part Comprehensive Osteopathic Medical Licensure Examination for osteopathic physician licensure, is exploring score reporting changes to its examination. With a single accreditation system for GME nearing completion this year, there may be opportunities for collaboration to ease the transition from UME to GME for all medical students."

Opening line is kind of the middle finger to DO students, they make a lot of money off this because less DO students take Step 2 than Step 1. However if they get rid of the NBOME I will sing them praises. Ironically the first author is a DO.....

"The USMLE program will continue to work with UME and GME communities and others as they explore a process that supports a career journey for physicians that the public can trust."

This is the same garbage the NBOME uses to rationalize its existence. "Protecting the public" is a shield to hide from criticism.

However this right here might be the most telling line of all:

"While there was no unanimity among the various groups about the best path forward, following an internal review of possible Step 1 score reporting options, including the possibility of no changes or the adoption of other types of scoring, the staff and governance of the FSMB and NBME aligned around one decision—reporting Step 1 results as pass/fail."

I.e. "we know you didn't want this but we decided we were going to do it anyway."

Congratulations NBME, you just gave definitive evidence that you didn't really give this any actual foresight.

Exactly - since it was in JAMA (and we know the AMA said that their "student and resident members voted to do support this" even though we did no such thing) I knew it would largely be defending it. I liked this one a bit better:

Reporting USMLE Step 1 Scores as Pass/Fail: Where Does It Leave Students?

This one talked a bit more about the disadvantages we've hashed out here. Particularly, stating in no uncertain terms that the unintended consequences can include reliance upon subjective clerkship grades and med school prestige (in the paragraph discussing prestige, they even stated that the weight placed on step 1 could simply be shifted to the MCAT as pressure increases to get accepted to more prestigious schools, which I appreciate), as well as weight shifting to step 2 CK.

Interestingly, it was written by students and not currently practicing physicians, which could be either bad or good depending on how you look at it.

They do mention shelf scores as a possible replacement, as well as the potential for specialties to develop their own specific standardized competency exams.

The article you linked cites a couple papers that show that increasing CK score is statistically associated with reduced disciplinary rates and reduced patient mortality of the physicians who took it. Which is great... but still, that exam is taken right before you apply to residency, so if the point here was wellness, it really did NOT have its intended effect as the pressure is even greater now.

 

[longhaul3]

"Many osteopathic medical students take Step 1 and Step 2 Clinical Knowledge to compete for residency positions and, given this change, more students may be prompted to take Step 2 Clinical Knowledge. The National Board of Osteopathic Medical Examiners, which produces the 3-part Comprehensive Osteopathic Medical Licensure Examination for osteopathic physician licensure, is exploring score reporting changes to its examination. With a single accreditation system for GME nearing completion this year, there may be opportunities for collaboration to ease the transition from UME to GME for all medical students."

Opening line is kind of the middle finger to DO students, they make a lot of money off this because less DO students take Step 2 than Step 1. However if they get rid of the NBOME I will sing them praises. Ironically the first author is a DO.....

I don't know much about the DO world and the pros/cons of taking USMLEs, but Step 1 is not a requirement to take Step 2CK. My basic understanding is that DO students currently take Step 1 to demonstrate academic equivalence to their MD counterparts. Taking Step 1 for a pass would seem unnecessary if they can take CK for a score to accomplish the same thing.

 

[slowthai]

I don't know much about the DO world and the pros/cons of taking USMLEs, but Step 1 is not a requirement to take Step 2CK. My basic understanding is that DO students currently take Step 1 to demonstrate academic equivalence to their MD counterparts. Taking Step 1 for a pass would seem unnecessary if they can take CK for a score to accomplish the same thing.

Actually, I wonder if PDs will now require a passing step 1 for consideration. Obviously, for MDs they need it to be eligible for graduation/licensure, so they'll have it regardless. But what about for DOs? If they do require it, then the NBME will have a guaranteed cash influx with DOs having to take step 1 + 2 without them even having to enforce it with a policy change. And even if PDs don't require it, I imagine a blank space on ERAS for a P/F step might raise unwanted questions for DOs, even with a solid step 2.

 

[Matthew9Thirtyfive]

Actually, I wonder if PDs will now require a passing step 1 for consideration. Obviously, for MDs they need it to be eligible for graduation/licensure, so they'll have it regardless. But what about for DOs? If they do require it, then the NBME will have a guaranteed cash influx with DOs having to take step 1 + 2 without them even having to enforce it with a policy change. And even if PDs don't require it, I imagine a blank space on ERAS for a P/F step might raise unwanted questions for DOs, even with a solid step 2.

Why would they care if you have a P on step 1 when you have a passing level 1 score and a solid step 2?

 

[slowthai]

Why would they care if you have a P on step 1 when you have a passing level 1 score and a solid step 2?

I don't know. I'm just speculating. I wonder if most PDs would consider a passed level 1 to be equivalent to a passed step 1.

 

[Ho0v-man]

Why would they care if you have a P on step 1 when you have a passing level 1 score and a solid step 2?

If they can find a reason to think less of the DO applicant, they will.

 

[AnatomyGrey12]

If they can find a reason to think less of the DO applicant, they will.

I agree, that is a VERY easy screen.

 

[slowthai]

If they can find a reason to think less of the DO applicant, they will.

This was my exact thought process when I wrote what I wrote, lol.

 

[premedchicc95]

Do we think that the date for this rollout is gonna get changed bc of this COVID chaos?

 

[greentealeaves]

Do we think that the date for this rollout is gonna get changed bc of this COVID chaos?

I'm going to guess yes.

 

[dohopeful13]

Honestly I don't see how much of an impact this would have. It's not like they are fundamentally changing the scoring. They are just converting all numeric scores to "P." If they do delay it, I don't think it would be because of this.

I think it's definitely possible, given that they seem to not fleshed out much of the plan to begin with, and the deadline was intentionally made a soft one for a reason. Not saying it will, but it definitely could. They never officially confirmed conversion of existing scores to a P either. It will likely happen but it's not confirmed

 

[Matthew9Thirtyfive]

Do we think that the date for this rollout is gonna get changed bc of this COVID chaos?

Doubt it. This isn’t even going into effect until at least 2022.

 

[NeuResurgens]

I wonder if the NBME could get around the problem of having people within the same classes pitting scores vs. Ps against one another by scoring based on graduation date instead of policy at the time of them talking the exam? There's the problem of people with a score taking unexpected time off and joining a P class, but that likely represents a much smaller number than just slapping a hard date for P vs. score causing discrepancies in the same classes based on when step 1 is taken.

 

[efle]

I wonder if the NBME could get around the problem of having people within the same classes pitting scores vs. Ps against one another by scoring based on graduation date instead of policy at the time of them talking the exam? There's the problem of people with a score taking unexpected time off and joining a P class, but that likely represents a much smaller number than just slapping a hard date for P vs. score causing discrepancies in the same classes based on when step 1 is taken.

They're gonna have to build the policy around the match cycle. E.g. "For the ERAS of Sept 2022, all applications will report only Pass. Students who tested prior to Jan 1 2022 and received a numerical score will have their number converted to a Pass on their application."

There's no other way to deal with it really, since even in the same graduating year some schools take it as MS2 right after preclinical finishes and some take it as MS3 after doing most of their cores.

 

[texan2016]

I wonder if the NBME could get around the problem of having people within the same classes pitting scores vs. Ps against one another by scoring based on graduation date instead of policy at the time of them talking the exam? There's the problem of people with a score taking unexpected time off and joining a P class, but that likely represents a much smaller number than just slapping a hard date for P vs. score causing discrepancies in the same classes based on when step 1 is taken.

That seems like it makes a lot of sense honestly

 

[ace_inhibitor111]

I wonder if the NBME could get around the problem of having people within the same classes pitting scores vs. Ps against one another by scoring based on graduation date instead of policy at the time of them talking the exam? There's the problem of people with a score taking unexpected time off and joining a P class, but that likely represents a much smaller number than just slapping a hard date for P vs. score causing discrepancies in the same classes based on when step 1 is taken.

It’s an absolute life changer for someone with a below average score to wait a year and suddenly be able to compete for any specialty (or for location), especially if they plan on doing a research year and can publish more research compared to the graduating class. I’d estimate probably 25-30% of those with below average scores would opt to wait for P/F (5,000+ ppl)

 

[efle]

It’s an absolute life changer for someone with a below average score to wait a year and suddenly be able to compete for any specialty (or for location), especially if they plan on doing a research year and can publish more research compared to the graduating class. I’d estimate probably 25-30% of those with below average scores would opt to wait for P/F (5,000+ ppl)

Yup, and considering the havoc that COVID19 is wreaking on people's application timelines for this year, I think were also going to see a ton of research years taken this year that might roll into a second research year to have a Pass for Step 1.

Small competitive specialties like ENT have had match rates as low as 75% in recent years. Would not be surprised at all if the next 1-2 match cycles are particularly forgiving/less crowded followed by 1-2 of the harshest years ever.

 

[NeuResurgens]

They're gonna have to build the policy around the match cycle. E.g. "For the ERAS of Sept 2022, all applications will report only Pass. Students who tested prior to Jan 1 2022 and received a numerical score will have their number converted to a Pass on their application."

There's no other way to deal with it really, since even in the same graduating year some schools take it as MS2 right after preclinical finishes and some take it as MS3 after doing most of their cores.

I guess that's sort of what I was thinking of - report the same way for all students who are joining a residency in a certain cycle

 

[Matthew9Thirtyfive]

I guess that's sort of what I was thinking of - report the same way for all students who are joining a residency in a certain cycle

That’s the only way I can see them doing it where they don’t piss absolutely everyone off.

 

[Ho0v-man]

That’s the only way I can see them doing it where they don’t piss absolutely everyone off.

Lol I don’t think they GAF about who they piss off. I think they’re harbingers of madness who will be ready soon enough with another cash grab test series to correct the problems they’ve created.

 

[Matthew9Thirtyfive]

Lol I don’t think they GAF about who they piss off. I think they’re harbingers of madness who will be ready soon enough with another cash grab test series to correct the problems they’ve created.

Also a very real possibility.

 

[slowthai]

You might need a passed step 1 in order to register for Step 2

Currently, you don't. You need a passed step 1 in order to take CS but not CK.

 

[efle]

Currently, you don't. You need a passed step 1 in order to take CS but not CK.

They better change that or they're gonna see some insanity start coming out of new MS1s. Can you imagine people in preclinical walking around flashcarding UpToDate algorithms for clinical management? That's coming next if they leave it possible to take a scored Step 2 CK straight after preclinical

 

[Matthew9Thirtyfive]

They better change that or they're gonna see some insanity start coming out of new MS1s. Can you imagine people in preclinical walking around flashcarding UpToDate algorithms for clinical management? That's coming next if they leave it possible to take a scored Step 2 CK straight after preclinical

If they didn’t want that, they shouldn’t have made this mess.

 

[efle]

If they didn’t want that, they shouldn’t have made this mess.

I see it more like a parent dealing with a toddler, except the toddlers are American physicians and medical students.

"You abused your Step 1 privileges when we let you see scores, so we're taking those privileges away. I'm going to leave Step 2 privileges for now and let's see if you learned a lesson."

 

[Matthew9Thirtyfive]

I see it more like a parent dealing with a toddler, except the toddlers are American physicians and medical students.

"You abused your Step 1 privileges when we let you see scores, so we're taking those privileges away. I'm going to leave Step 2 privileges for now and let's see if you learned a lesson."

I’m too cynical for that. I’m betting there is a huge plan where they will roll out a p/f step 2 for the same reason and then roll out a whole new series of exams that students have to pay for.

 

[Ho0v-man]

I’m too cynical for that. I’m betting there is a huge plan where they will roll out a p/f step 2 for the same reason and then roll out a whole new series of exams that students have to pay for.

This is exactly what will happen. We have to take steps for licensure (well not me livin dat none wizard life) but then have to take their new “optional” tests to match competitively. Best part? I’m going to guess they’ll just recycle step 1&2 questions bc they’re too lazy to make new ones. Love it!

 

[NeuResurgens]

They better change that or they're gonna see some insanity start coming out of new MS1s. Can you imagine people in preclinical walking around flashcarding UpToDate algorithms for clinical management? That's coming next if they leave it possible to take a scored Step 2 CK straight after preclinical

They could require completion of core clerkships by the exam date and schools could all verify that because schools already have to verify you to NBME before they give you your testing permit.

I see it more like a parent dealing with a toddler, except the toddlers are American physicians and medical students.

"You abused your Step 1 privileges when we let you see scores, so we're taking those privileges away. I'm going to leave Step 2 privileges for now and let's see if you learned a lesson."

I think you're giving the NBME too much credit. The NBME wants to make money - they're not trying to teach anybody a lesson (and also, who really thinks programs won't start using CK scores more? there's no lesson to be learned here). And was using scores as residency selection really an abuse? What did the NBME think would happen when they created the scored version? Why didn't they make it pass/fail in the first place if it was only intended to show baseline competency? Scores literally only exist to stratify on a spectrum, everyone in education knows that and they knew this when they created the exam as a scored entity. I think there's more politics behind this decision more so than any actual care about the "welfare of students," despite what they say. Like I've said, this decision only increases reliance on subjective measures, which is going to be inherently more stressful to students due to their inability to control these kinds of factors..

 

[efle]

They could require completion of core clerkships by the exam date and schools could all verify that because schools already have to verify you to NBME before they give you your testing permit.



I think you're giving the NBME too much credit. The NBME wants to make money - they're not trying to teach anybody a lesson (and also, who really thinks programs won't start using CK scores more? there's no lesson to be learned here). And was using scores as residency selection really an abuse? What did the NBME think would happen when they created the scored version? Why didn't they make it pass/fail in the first place if it was only intended to show baseline competency? Scores literally only exist to stratify on a spectrum, everyone in education knows that and they knew this when they created the exam as a scored entity. I think there's more politics behind this decision more so than any actual care about the "welfare of students," despite what they say. Like I've said, this decision only increases reliance on subjective measures, which is going to be inherently more stressful to students due to their inability to control these kinds of factors..

Their stated reasoning for showing scaled scores was so that testers (and med schools) could see how widely people had cleared the Pass threshold. There is absolutely no way that in 1992, they expected their median would become our fail threshold, or that getting an 82% versus 88% would drastically change your specialty and program options.

And I definitely don't think the net effect of Step 1 Mania was a reduction in student stress levels. It's been increasing per the faculty that have watched it. The unknown is always scary to the first cohort (much like COVID for my year). But if we bump this thread in the year 2030, the current med students will no doubt laugh us off the forums for claiming our setup was the most fair or sensible or identified the best residents.